Outcome of Pediatric Patients With Pulmonary Arterial Hypertension in the Era of New Medical Therapies

Rosa Laura E. van Loon, Marcus T. R. Roofthooft, Tammo Delhaas, Magdalena van Osch-Gevers, Arend D. J. ten Harkel, Jan L. M. Strengers, Ad Backx, Hans L. Hillege, Rolf M. F. Berger*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

93 Citations (Scopus)

Abstract

Little is known about the effects of "second-generation drugs" (prostanoids, endothelin receptor antagonists, 5-phosphodiesterase inhibitors) in children with pulmonary arterial hypertension (PAH). This study describes the outcome of a national cohort of children with PAH in an era when these drugs became available. From 1993 to 2008, 52 consecutive children with idiopathic PAH (n = 29) or systemic-to-pulmonary shunt-associated PAH (n = 23) underwent baseline and follow-up assessments. Treatment was initiated depending on functional class, acute pulmonary vasoreactivity response, and drug availability. Observed survival was evaluated depending on time of diagnosis in relation to second-generation drug availability and subsequently compared to calculated predicted survival. Children for whom second-generation drugs were available had improved survival compared to their predicted survival (1-, 3-, and 5-year survival rates 93%, 83%, and 66% vs 79%, 61%, and 50%, respectively). However, this improved survival was observed only in patients for whom second-generation drugs became available during their disease course. No improved survival was observed in patients for whom drugs were available already at diagnosis. Baseline variables associated with decreased survival included higher functional class, higher pulmonary-to-systemic arterial pressure ratio, lower cardiac index, and higher serum levels of N-terminal pro brain natriuretic peptide and uric acid. After start of second-generation drugs, functional class, 6-minute walking distance, and N-terminal pro brain natriuretic peptide improved but gradually decreased after longer follow-up. In conclusion, survival of pediatric PAH seemed improved since the introduction of second-generation drugs only in selected patients for whom these drugs became available during their disease course. Start of second-generation drugs initially induced clinical improvements, but these effects decreased after longer follow-up. (C) 2010 Elsevier Inc. All rights reserved. (Am J Cardiol 2010;106:117-124)

Original languageEnglish
Pages (from-to)117-124
Number of pages8
JournalAmerican Journal of Cardiology
Volume106
Issue number1
DOIs
Publication statusPublished - 1-Jul-2010

Keywords

  • CONGENITAL HEART-DISEASE
  • 1ST-LINE BOSENTAN
  • WALK TEST
  • CHILDREN
  • SURVIVAL
  • VALUES
  • ADULTS
  • DRUG

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